We recently had the opportunity to meet with Galen Kam, M.D. specifically to talk about his background, and his experiences using the InSet™ glenoid from Shoulder Innovations.
Dr. Galen Kam is an Orthopedic Surgeon in Las Vegas, NV.
David Blue: Dr. Kam, would you please share your background with us, including how you became involved in healthcare and specifically orthopedics?
Dr. Kam: Well, I’m originally from Hawaii. I grew up in, born and raised in Hawaii. Probably had a little bit of interest in, at least, science going through high school, and biology was sort of my favorite thing. That kind of naturally led into at least considering a career in medicine.
I got into medical school and enjoyed it. Actually, I originally was thinking about being a cardiologist, because I had done a lot of research in cardiology when I was an undergrad working in a lab, so originally, when I was in medical school, I was thinking about going into internal medicine until I did a rotation in orthopedics.
After that, I kind of fell in love with the idea of orthopedic surgery, more so than medicine, simply because surgery is one of those things that you’re faced with a problem, typically, you can find a solution to that problem, and there’s an endpoint to the problem that you’re taking care of.
Internal medicine, sometimes you’re just taking care of chronic disease for a patient’s lifetime, and you’re more of treating a disease rather than solving a problem. I think that’s one of the attractive things about orthopedics, at least for me at that time.
David Blue: What was it that attracted you specifically to shoulder and elbow as a specialty?
Dr. Kam: In residency, I trained with a shoulder and elbow surgeon at USC, and we dealt with a lot of complex shoulder and elbow problems. There’s something about the complexity and the uniqueness about the shoulder and elbow that kind of drew me into the field.
For whatever reason, a lot of people and general orthopedic surgeons don’t like to deal with bad shoulder and elbow problems. I can’t give you a really solid reason why, but the complexity of the surgeries kind of attracted me.
Part of it had to do with my mentor. You tend to gravitate towards people that you feel some type of connection with, and my mentor kind of gave me some guidance that that really resounded with me. I kind of identified with him a lot, and that’s another reason why I ended up looking at shoulder and elbow as a subspecialty.
David Blue: How did you first learn about the InSet™ Glenoid, and the Shoulder Innovations team?
Dr. Kam: A lot of it is I’ve had relationships with several members of the team from, well, even when I was a fellow in training.
Several of the guys who are part of Shoulder Innovations were part of other companies at that time, and so we developed a professional relationship.
A lot of the people who run Shoulder Innovations are very relationship-based people, and so they get to know you as a person, and that sort of kept our connection over all of these years.
When they were working with Shoulder Innovations, they contacted me and told me what they were working on, and that’s sort of how I got interested in it.
David Blue: What was your initial impression of Shoulder Innovations and the concept of the InSet™ glenoid?
Dr. Kam: Well, it’s a paradigm shift, and it’s something that’s different than what we’ve used, I mean, ever since I was in training.
Even though the concept is different, the logic behind it, the way that it is explained and how the company puts it across just intuitively makes sense. Then, on top of that, they back it up with at least some early testing and early literature. That helps you buy even more into the idea that this could be something that changes the way we do the glenoid instrumentation.
I think that’s what started me on the path, and then just utilizing it in a lab setting, first, and then finally in the patient, you really get to see how different it is, how easy it is, and how reproducible it is.
David Blue: What has been your personal experience in using the InSet™ glenoid?
Dr. Kam: Well, I was a cautious adopter at first. I’m not one to jump two feet in or all in with new technology. I kind of want to ease my way into it.
So, I started off with a pretty straightforward case, and the one thing I can say is that I’m always suspect that we don’t instrument the glenoid as well as we think we did with what’s considered the standard of care type of glenoid, the onlay glenoid. I would think it’s a very fine line between perfect and imperfect, and I think to do the surgery properly, you need to be as perfect as you can be.
The instrumentations for Shoulder Innovations and the way that this glenoid is thought to be used is such a simple prep, and it’s a reliable preparation that every time I use it, I always think you have to try hard to do a bad preparation. It’s a very easy thing to do, and I think if we can make something easy and reproducible, I think it makes the surgery that much more reliable.
I started off with an easy case, saw that I could do this surgery in a way that I don’t think I ever could before, and leave that part of the operation with a confidence that I never did before.
After the easy case, I went to a little bit harder case with some mild deformity, and that went relatively well.
Then, I went to a case with severe deformity, and that went pretty well too.
To go along with that, the patients’ clinical outcomes were fairly good, and my first three patients started to make me a believer in the technique. So now, whenever I do an anatomic total shoulder, that is my glenoid of choice.
My glenoid component of choice has become the SI InSet™ glenoid.
David Blue: If you were sitting down with a fellow surgeon to talk to them about this technology for the very first time, what would you tell them?
Dr. Kam: I think I would want to hear what their experience is with their own technique of glenoid preparation, and then I would tell them the whole reason I would consider using this new product is I think once you get your hands on it and once you try it, you will see how much more the implant is just so solid from the time you put it in.
There’s no question of whether it’s going to wobble or not, whether it’s going to feel unstable or not. Every case I’ve put it in, I can set the trial in. I can try and wiggle it or I can try and stress it, and it really doesn’t move. Then, I know when I put my final implant, that it’s going to be a very solid construct.
I think since we know that the failure of total shoulders comes from the glenoid side if we can leave the operating room thinking, “That’s as good as I can make it,” that’s a big deal.
David Blue: Do you have any tips or pieces of advice that you would give other surgeons if they were using the system for the first time?
Dr. Kam: The one thing I would say, I always say it to myself – I have to set it up a little bit higher than where I would think it would go, because its shape, the round shape of it, is different than the pear-shaped glenoids we’re used to. So your eye wants to set it down a little bit too low because that’s the big area of the glenoid. You want to intuitively seat it where there’s the most amount of bone.
Instead, I feel you have to shift it up a tiny bit to actually be in the center of the glenoid. That’s something I have to play with a little bit to really understand that my eye is fooling me, and I have to shift a little bit more superior to get the optimal position.
I still use x-ray to confirm that in surgery, but it’s now to the point where it just confirms it rather than where I’m adjusting over and over again. I just use it to confirm that I have it in the right place, but that’s the one thing I’ve learned over time.
Then, the other thing I would tell people is don’t go with your hardest case first. Start with a relatively straightforward case. Get used to the instrumentation. Get used to the technique to build a little bit of confidence. Then from that point on, it’s pretty straightforward after that.
David Blue: Do you have any additional thoughts or comments you would like to add?
Dr. Kam: Maybe just to say it in a different way, I think that this glenoid is different enough, and we need something different to help manage the glenoid, just because of the known issues with failure on that side.
This particular implant, I truly think that it is a game-changer when it comes to how easy it is to put in, how reliable it is, and, again, the confidence that you have with putting it in is so different than every other system I’ve tried, and I’ve tried a lot. It’s that good, and I don’t often say things like that about an implant system, but this one is that good.
I think the team has done an excellent job of refining the instrumentation, making it simple, that I think whether you’re an experienced surgeon or whether you just do a few of these a year, I think that it can be done properly with the technique. I think that’s something you can’t say for every shoulder system out there because we know that a lot of shoulder replacements are done by guys who don’t do that many a year, less than five, and so if you can put a system in their hands that’s very simple to use, straightforward, and it makes the surgery that much more attractive to that kind of surgeon.